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Methods for quality development on the primary health care structure
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe and analyse methods for quality development of the Swedish primary health care structure. Specific aims were as follows. To describe and test a medical-audit method of determining the optimum level of outpatient medical care. To describe and test the tracer-condition methodology for quality assessment of the medical care delivered by the primary health care. To describe and test a practice-visiting method to compare the total qualities of primary health care centres in order to facilitate quality improvement. To describe and test Donabedian's method (structure, process, outcome) of evaluating a health-promotion programme giving special attention to outcome. To use register data as a method to analyse important determinants of hospitalisation rates and whether the primary health care has any influence.

Different methods for quality development, such as peer review, medical audit, practice-visiting and tracer-condition technique, were used in order to evaluate the quality of care at the primary health care centres and to identify the role of primary health care in the total health care system. Papers I-V were based on studies of everyday activities in ordinary health care centres and hospitals in three counties in southern Sweden during 1987-2000.The methods used were chosen and adapted for the purpose of the studies.

It was agreed upon that about 75% of the outpatient visits to a doctor could be managed by a general practitioner (GP) (Paper I). There was no difference in quality when patients with insulin-treated diabetes mellitus visiting a GP were compared with those visiting a doctor at a hospital (Paper II). Practice-visiting proved to be a suitable method of comparing different primary health care centres with respect to medical quality (Paper III). A health promotion progrannne could be integrated into the everyday work at the health centres and was found to improve lifestyle habits and influence cardiovascular risk factors (Paper IV). The most important determinants of hospitalisation rates were age, the proportion of the population born abroad, the structure of the health care organisation, and the number of outpatient visits to hospital (Paper V).

The different methods which have been described need to be adapted to Swedish primary health care. The methods described in this thesis (medical audit, the tracer-condition method, practice-visiting and Donabedian's method) were usable for the purposes described. Register studies yielded valuable information in analysing important factors for explaining hospitalisations.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2002. , 65 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 719
Keyword [en]
Quality development, primary health care, evaluation, medical audit, tracercondition method, practice-visiting, health promotion, register study
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26342Local ID: 10866ISBN: 91-7373-161-7 (print)OAI: oai:DiVA.org:liu-26342DiVA: diva2:246890
Public defence
2002-07-01, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-17Bibliographically approved
List of papers
1. Medical audit used for estimation of optimum level of outpatient care
Open this publication in new window or tab >>Medical audit used for estimation of optimum level of outpatient care
1995 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 13, no 3, 175-181 p.Article in journal (Refereed) Published
Abstract [en]

Objective - To create a model for determining the optimum level of outpatient medical care and to determine this level.

Design - Expert committees were established comprising one or two hospital physicians and two general practitioners who checked medical records for all outpatient visits to doctors made by a defined population during a defined period of time. the determination of optimum level was made blindly by each member of the expert committee.

Setting and participants - the study comprised all visits to physicians during 10 weeks, in total more than 4000, made by the people in a Swedish community, of which 2084 were randomized.

Results - Total agreement between the members of the committee was initially reached for 84% of the visits and, after a common discussion between the committee members, for 99%. A general practitioner was considered to be the optimum level of care for 76% of the patients in the total series, in the upper ages (above 80) for about 85%.

Conclusion - This method seemed suitable for determining the optimum level of care in a population and may be of value when planning for an optimum health care service. Based on the results from our study it seems reasonable to assume that general practitioners whose training corresponds to that of Swedish ones are competent to treat about 75% of all consultations.

Place, publisher, year, edition, pages
Informa Healthcare, 1995
Keyword
medical audit, level of care, outpatient care, primary health care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81481 (URN)10.3109/02813439508996758 (DOI)
Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2017-12-07Bibliographically approved
2. A model for quality assessment in primary health care using the tracer condition technique with insulin treated diabetes as one of the tracers
Open this publication in new window or tab >>A model for quality assessment in primary health care using the tracer condition technique with insulin treated diabetes as one of the tracers
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1997 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 15, no 2, 92-96 p.Article in journal (Refereed) Published
Abstract [en]

Objective-To find a method for quality assessment in primary health care and to apply this method on a defined disease.

Design-General practitioners and hospital doctors worked out a programme for evaluating the quality of outpatient care of patients with insulin treated diabetes as one of five tracers. An expert committee comprising experienced general practitioners and hospital doctors compared two health centres with one outpatient medical department Data were collected during a defined period combined with a one-year retrospective view, official statistics on medical care, and a questionnaire completed by the patients.

Setting-Two primary health care centres and one outpatient medical department in southwestern Sweden.

Patients-243 insulin treated diabetic patients attending the hospital and 87 insulin treated patients attending the health centres.

Main results-There were no difficulties for the expert panel to agree on which indicators were to be studied. The expert panel concluded that there was no difference between the quality of the two levels of care studied.

Conclusions-Medical audit was a useful method for evaluating medical quality. Co-operation between hospital doctors and general practitioners was of great value for evaluation of the quality of primary health care.

Place, publisher, year, edition, pages
Informa Healthcare, 1997
Keyword
quality assurance, insulin treated diabetes, primary health care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81482 (URN)10.3109/02813439709018494 (DOI)
Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2017-12-07Bibliographically approved
3. Facilitating quality improvement in primary healthcare by practice visiting
Open this publication in new window or tab >>Facilitating quality improvement in primary healthcare by practice visiting
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1998 (English)In: Quality in Health Care, ISSN 0963-8172, Vol. 7, no 1, 48-54 p.Article in journal (Refereed) Published
Abstract [en]

No abstract available.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81483 (URN)10.1136/qshc.7.1.48 (DOI)
Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2012-09-17Bibliographically approved
4. Evaluation of “Live for Life”, a health promotion programme in the County of Skaraborg, Sweden
Open this publication in new window or tab >>Evaluation of “Live for Life”, a health promotion programme in the County of Skaraborg, Sweden
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2001 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 55, no 4, 277-282 p.Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVE To evaluate a health promotion programme, combining a population and individual based strategy, in the County of Skaraborg, Sweden, with special attention to outcome.

DESIGN The evaluation was subdivided into structure, process and outcome. The evaluation procedure as a total is described here, but the results presented refer only to outcome. In order to study the potential effect of the individually based health examination, 35 year old subjects who had participated five years previously were in 1994–1996 compared with 35 year old subjects who had not participated before, and compared with their own values five years earlier. The results during 1995–1996 were compared with those of 1989–1990 for corresponding ages in order to study the effect of, particularly, the population based strategy.

SETTING The County of Skaraborg in the south western part of Sweden with about 270 000 inhabitants. In addition to population strategy, involving the total county, men and women aged 30 and 35 years were invited to an individually based examination.

MAIN RESULTS Factors related to body weight increased during the study period, while other factors mostly changed in the direction wanted. As a whole the changes were rather modest. There were favourable changes in lifestyle variables, for example, concerning smoking and dietary habits.

CONCLUSIONS There were beneficial effects from the health promotion programme, but there is a need for continuous improvement of methods of intervention referred to lifestyle.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81485 (URN)10.1136/jech.55.4.277 (DOI)
Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2017-12-07Bibliographically approved
5. Determinants of hospitalisation rates: does primary health care play a role?
Open this publication in new window or tab >>Determinants of hospitalisation rates: does primary health care play a role?
2003 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 1, 15-20 p.Article in journal (Refereed) Published
Abstract [en]

Objective - To analyse the influence of rates of general practitioner visits on rates of hospitalisations.

Design  - Ecological cross-sectional study of factors influencing hospitalisation rates. Aggregated data on primary care centre area level.

Setting - The county of Östergötland, Sweden, with 3 hospital districts and 41 primary health care centres, and the hospital district of Jönköping in the county of Jönköping, Sweden, with 11 primary health care centres.

Outcome measure - Hospitalisation rates.

Results  - Age and rates of outpatient hospital visits were the most important factors explaining the variation in rates of hospitalisations between the primary health care centre areas. Hospital districts, socioeconomic factors and rates of GP visits also influenced the rates of hospitalisations.

Conclusion - When evaluating the influence of primary health care on the rates of hospitalisations, both socioeconomic factors and health care structure must be taken into consideration. Doing this, the rates of GP visits correlated negatively with the rates of hospitalisations.

Keyword
Health Care Structure, Hospitalisation, Primary Care, Socioeconomic Factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13653 (URN)10.1080/02813430310000500 (DOI)
Available from: 2004-06-23 Created: 2004-06-23 Last updated: 2012-09-17Bibliographically approved

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